Provider Demographics
NPI:1578989232
Name:INNOVATIVE SURGICAL CARE, PC
Entity Type:Organization
Organization Name:INNOVATIVE SURGICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATANASSOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-776-2991
Mailing Address - Street 1:1350 BELMONT ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:774-776-2991
Mailing Address - Fax:774-776-2996
Practice Address - Street 1:1350 BELMONT ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-776-2991
Practice Address - Fax:774-776-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty